Advisor Claims Business Analyst

Gainwell Technologies LLC•Any city, OH

2d•Remote

About The Position

As an Advisor Claims Business Analyst at Gainwell, you will support end-to-end claims workflow analysis, configuration support, and complex issue resolution within the MMIS ecosystem. This role provides advanced (L2) support for claims operations by leveraging deep expertise in Medicaid claims adjudication, data analysis, and cross-functional collaboration. You will drive root-cause analysis, identify trends, and recommend solutions that improve first-pass rates, reduce denials, and support client and organizational objectives.

Requirements

9+ years of experience in claims business analysis, configuration, or healthcare operations, with strong experience in end-to-end claims workflows
Advanced knowledge of healthcare claims processing, including coding (ICD-10, CPT, modifiers), billing, and adjudication rules
Strong SQL skills and experience analyzing large datasets to identify trends, root causes, and performance improvements
Proven ability to solve complex issues, translate technical findings into business insights, and work within client/vendor environments
Strong communication, collaboration, and stakeholder engagement skills; experience in Medicaid or Medicare environments preferred

Responsibilities

Analyze claims data to identify denial trends, operational bottlenecks, and opportunities to improve first-pass rates and reduce rework
Perform in-depth investigation of complex claims issues, determining root causes across policy, data, user, or configuration factors
Provide actionable recommendations and detailed documentation to support issue resolution, enhancements, and system improvements
Collaborate with cross-functional teams (e.g., operations, IT, policy, finance) to reconcile claims outcomes and ensure data integrity
Develop reporting, dashboards, and monitoring tools to provide insights and support leadership decision-making